Healthcare Provider Details

I. General information

NPI: 1245800416
Provider Name (Legal Business Name): ANDREW JAMES SKOKAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 MONO WAY SUITE G
SONORA CA
95370-2824
US

IV. Provider business mailing address

13975 MONO WAY STE G
SONORA CA
95370-2824
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-9600
  • Fax:
Mailing address:
  • Phone: 209-533-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: